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Ostomy Pouch, Urinary, One-Piece, Extended Wear

Utah rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Rates data updated July 2026.

How much does Ostomy Pouch, Urinary, One-Piece, Extended Wear cost?

$7.08

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $7.08 for this service. The price depends on where it is billed: about $7.08 from a physician practice, and about $2.69 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$7.08$5.01 to $10.47
FacilityA hospital or hospital-owned outpatient department$2.69$2.69 to $3.31

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $6Professionalmedian $7 · 10th to 90th $3 to $43
$5$10$20facility $3professional $7

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$2.69
Typical High
$2.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$6.46
Typical High
$42.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$6.92
Molina
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$7.24
Typical High
$9.77
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$7.08
Typical High
$10.96
Select Health
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$10.00
Select Health
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$10.00
Typical High
$10.00
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$10.00
Typical High
$12.02
United
Setting
Facility
Modifier
Global
Typical Low
$3.31
Median
$3.80
Typical High
$4.17
United
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$4.17
Typical High
$6.31

Where Utah sits

The same service costs 2.2 times more in Hawaii than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 20th of 51

$7.08

HI $10.96CO $4.90

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.